Clinical Orthopaedics and Related Research, Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, http://dx.doi.org/10.1007/s11999-015-4159-3, Articles in PubMed by James I. Cameron, MD, Articles in Google Scholar by James I. Cameron, MD, Other articles in this journal by James I. Cameron, MD, Privacy Policy (Updated December 15, 2022). The success rate also depends upon the amount of arthritis of the lateral compartment, if there is a concurrent meniscal transplant or cartilage resurfacing procedure, and also if the patient is not significantly overweight (with a high body mass index, BMI). Additional procedures at the time of lateral opening-wedge distal femoral osteotomy. The authors reported 18 of 19 patients were satisfied. Additionally, each screw can be pivoted within the plate's mobile bushing system to optimize placement prior to being locked to the plate, creating a rigid construct. Means and frequencies were calculated to describe patient characteristics of the study population, type of fixation and graft material, amount of intraoperative correction, and mechanical axis alignment. Conclusion: Distal femoral osteotomy is an acceptable surgical option for the young patient with severe unicompartmental knee osteoarthritis and malalignment. Epub 2021 Oct 27. In situations involving lateral unicompartmental arthritis unresponsive to conservative treatment options, the Distal Femoral Opening Wedge Osteotomy System is a safer, more reproducible alternative to traditional closing wedge distal femoral osteotomies. In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Preoperatively, the amount of correction was estimated using a simplified calculation of 1 mm of linear correction at the osteotomy site to 1 of correction of axial alignment. Joint line convergence angle (JLCA) = 5, mechanical lateral distal femoral angle (mLDFA) = 84. b Preoperative planning of opening-wedge (DFO). In general, it is felt that younger patients definitively should have a distal femoral osteotomy when it is indicated, whereas older patients may equally benefit from a distal femoral osteotomy or a total knee replacement, depending upon their overall activity levels, if they have other medical problems, and if their bone is relatively osteopenic (softer than normal). Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Intraoperative fluoroscopic and visual analysis of correction to neutral mechanical axis is not as accurate as we had anticipated. Joint preservation patients satisfied the criteria for osteotomy as described but were younger patients with a mean age of 26 years and were motivated to maintain an active lifestyle. This estimate was adjusted intraoperatively based on both clinical and radiographic analysis. 2022 Sep;142(9):2303-2312. doi: 10.1007/s00402-022-04495-1. The femur is cut with surgical instruments to about 1 cm away from the medial edge of the femur, commonly at a 45-degree angle and angling towards the adductor tubercle, and the bone is then slowly opened up to the point where the weightbearing goes through the center of the knee. Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Orthopedic Surgeon & Sports Medicine Specialist The opening-wedge plate was then placed and fixed with four screws (Fig. 20. 2016 Jun 6;4(6):2325967116649901. doi: 10.1177/2325967116649901. The purpose of our study was to report on a series of opening-wedge distal femoral varus osteotomies used to treat osteoarthritis of the lateral compartment or as an adjunct to correct malalignment with cartilage or meniscal restoration. Ramanathan, Deepak, Arvind Von Keudell, Tom Minas, and Andreas H. Gomoll. It is felt that if the valgus alignment is not corrected with a reconstruction of a chronic MCL tear, that there is a much higher risk the MCL tear will stretch out. The use of an opening-wedge osteotomy on the tibial side for varus deformity has become well established as the favored alternative to the previously more common closing-wedge techniques [8]. 7. Isolated high tibial osteotomy is appropriate in less than two-thirds of varus knees if excessive overcorrection of the medial proximal tibial angle should be avoided. and transmitted securely. Distal femoral varus osteotomy. Lower extremity malalignment in association with arthritis or cartilage deficiency is a clinical challenge. The ContourLock distal femoral osteotomy plates are designed to work in conjunction with the Osteotomy Instrument System. Bookshelf Patients who had any symptoms in the medial or patellofemoral compartment in addition to the lateral compartment were not considered for osteotomy. X-rays are taken at each visit to confirm healing and check alignment. Thin and low profile to prevent overlying soft-tissue irritation, the titanium plate is attached to bone using 4.5 mm and 6.5 mm cancellous screws that seat flush to the plate surface. Distal femoral varus osteotomy for osteoarthritis of the knee. Epub 2017 Sep 6. In this study we report on a cohort of patients who underwent this procedure either for symptomatic lateral compartment knee arthritis or in patients undergoing a joint preservation procedure. However, osteoarthritis continues to progress and multiple arthroscopic or open procedures may be required despite a successful osteotomy. A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Ehlinger M, D'Ambrosio A, Vie P, Leclerc S, Bonnomet F, Bonnevialle P, Lustig S, Parratte S, Colmar M, Argenson JN; French Society of Orthopedic Surgery, Traumatology (SoFCOT). Matsushita T, Mori A, Watanabe S, Kataoka K, Oka S, Nishida K, Nagai K, Matsumoto T, Hoshino Y, Kuroda R. Arch Orthop Trauma Surg. Relative disadvantages include potential for delayed union or nonunion and irritation of the sensitive lateral knee structures by hardware or surgical trauma. The fascia over the vastus medialis is incised and retracted laterally and anteriorly to expose the femoral shaft. Wayne M. Weil, M.D | At 74 months followup, the Lysholm scores improved from 64 to 77 and the clinical Hospital for Special Surgery knee score improved from 42 to 64. Survivorship at 10, 15, and 20 years was 90%, 79%, and 21.5%, respectively. Thin and low profile to prevent overlying soft-tissue irritation, the titanium plate is attached to bone using 4.5 mm and 6.5 mm cancellous screws that seat flush to the plate surface. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Seattle Shoulder Surgery | 8600 Rockville Pike In those patients who do have valgus alignment in these circumstances, a concurrent distal femoral osteotomy or a first stage distal femoral osteotomy would be indicated to give the cartilage replacement surgery or the lateral meniscal transplant the best chance to work over the long term. [3] reported one delayed union that prolonged rehabilitation and seven patients who required hardware removal. The indications for osteotomy included symptomatic lateral compartment arthritis with clinical valgus deformity or a cartilage or meniscal defect in the lateral compartment with clinical valgus alignment. A distal femoral involves a surgical cut of the bone at bottom of the femur. (2) What pain and function levels do patients experience after lateral opening-wedge osteotomy? A 57-year-old man presented to our orthopedic outpatient . Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. While this is very uncommon, putting weight on it before Dr. Garcia instructs you, high BMI or smoking can increase this risk. doi:10.1177/2325967114S00051. Objectives: Distal femoral osteotomy (DFO) is a useful procedure in the young patient with symptomatic unicompartmental osteoarthritis and valgus malalignment to avoid or postpone knee arthroplasty. pt13: proximal femoral plate removal pt14: chiari pelvic osteotomy (child with neurological impairment) pt15: san diego / degas pelvic osteotomy (child with neurological impairment) pt16: distal femoral rotational osteotomy pt17: distal tibial rotational osteotomy pt18: evan's calcaneal lengthening pt19: triple arthrodesis pt20: botox . [3] reported on 12 patients with an average age of 52 years undergoing opening-wedge distal femoral osteotomy with the Puddu plate. Wang and Hsu [20] reported on 30 knees undergoing varus osteotomy with a medial blade plate. Backstein D, Morag G, Hanna S, Safir O, Gross A. Oda T, Maeyama A, Yoshimura I, Ishimatsu T, Miyazaki K, Tachibana K, Yoshimitsu K, Yamamoto T. BMC Musculoskelet Disord. Improvement in pain and function of this procedure at intermediate-term followup has been acceptable [1, 2, 6, 7, 12, 13, 20]. The theoretical advantages of the opening-wedge technique over the medial closing-wedge technique include a single bone cut, avoidance of vascular structures, better control of the amount of correction, and more anatomic correction of the typical pathoanatomy of excessive distal femoral valgus [9]. This was an unexpected but noteworthy finding. Some distal femoral osteotomies involve taking out bone where you let the . Late recurrence of varus deformity after proximal tibial osteotomy. The next most common indication for a distal femoral osteotomy is when a patient is knock knee and needs a lateral meniscal transplant and/or a cartilage resurfacing procedure of the outside (lateral) compartment of their knee. Keywords: Previous attempts to make it better provided only temporary relief. Systematic review, Level of evidence, 4. Robert LaPrade, MD, PhD These studies report the correction of deformity and the pain and function of small cohorts of patients undergoing a medial closing-wedge distal femoral osteotomy for treatment of lateral compartment arthritis. Pain requiring hardware removal was the most commonly reported complication in both groups. However, as a result of the small sample size, it was not appropriate to test the change from preoperatively to followup statistically; thus, no p value is given. Opening wedge distal femoral varus osteotomy using the Puddu plate and calcium phosphate bone cement. I was life flighted to MCR in Loveland, CO. My orthopedic injuries were severe, but totally missesd by the orthopedic team at Poudre. Postoperative management included touchdown weightbearing for 6 weeks with no limits to ROM followed by 4 to 6 weeks of progressive weightbearing with the use of crutches. Its combination with various cartilage repair procedures has been shown to further improve outcomes. The frequency of hardware removal was higher than we expected and indicates that this should be discussed with patients preoperatively. Finkelstein JA, Gross AE, Davis A. Varus osteotomy of the distal part of the femur. Saithna A, Kundra R, Getgood A, Spalding T. Opening wedge distal femoral varus osteotomy for lateral compartment osteoarthritis in the valgus knee. For cartilage patients the cut off is slightly lower at 3-4 degrees of valgus. The most common complication was hardware pain (20.5%) followed by arthrofibrosis (12.8%). Between 2000 and 2010, we performed 40 distal femoral osteotomies. Your message has been successfully sent to your colleague. Other less common complications included hardware failure (3.8%), septic arthritis (3.8%) and nonunion (2.6%). *StimuBlast is a registered trademark of AlloSource. Some features of this site may not work without it. To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO. Epub 2019 Nov 27. I was hit by a car on my bicycle near Horsetooth Reservoir in CO. Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 1.5 years). Oftentimes, we will place the patient into a lateral compartment unloader brace to use as a screen to determine that a distal femoral osteotomy may be a useful procedure. Thirty-eight knees (97%) in 36 patients were lateral opening-wedge varus-producing osteotomies; of those, 31 knees (82%) in 30 patients had followup at a minimum of 2 years (mean, 5 years; SD, 2; range, 2-12 years) and comprised the study population. 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